Mental Health Psychotic Disorders What Is Undifferentiated Schizophrenia? An outdated, catch-all diagnosis when symptoms are difficult to classify By Heather Jones Updated on March 01, 2023 Medically reviewed by Michael MacIntyre, MD Print Table of Contents View All Table of Contents Definition Why It's Outdated Symptoms and Criteria Diagnostic Process Causes Treatment Coping Frequently Asked Questions Undifferentiated schizophrenia is an outdated term for a type of schizophrenia in which a person meets the criteria for the disorder but cannot be classified into just one of its four subtypes. While undifferentiated schizophrenia is no longer listed in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), some healthcare providers still use the term. Under the older definition, people with undifferentiated schizophrenia exhibit symptoms of more than one type of schizophrenia. These may include delusions, paranoia, hallucinations, and other symptoms that interfere with a person's sense of reality. This article explains what undifferentiated schizophrenia is and why the term is no longer widely used in the medical community. It also describes the symptoms of undifferentiated schizophrenia as well as the causes, diagnosis, and treatment of schizophrenia in the current context. Jonathan Knowles / Getty Images Definition of Undifferentiated Schizophrenia Schizophrenia is a mental health condition that interferes with a person's perception of reality. In earlier editions of the DSM, schizophrenia was divided into five subtypes. undifferentiated schizophrenia essentially served as a catch-all diagnosis when someone's symptoms did not fit neatly into any other category. Paranoid schizophrenia: "Positive symptoms," like delusions and hallucinations, are dominant Disorganized schizophrenia (hebephrenic schizophrenia): Cognitive and "negative symptoms," such as disorganized thought and disorganized speech, are dominant Residual schizophrenia: Criteria for schizophrenia are met, but symptoms are milder Catatonic schizophrenia: Criteria for schizophrenia are met and there are additional symptoms of catatonia (excessive or decreased movement) Undifferentiated schizophrenia: Symptoms of more than one subtype of schizophrenia are present, but a person does not exhibit enough of one to be classified as that subtype Why the Term Is No Longer Used The most recent edition of the DSM (DSM-5) no longer includes any of the five subtypes of schizophrenia. According to the American Psychiatric Association, the classifications have not proven to be reliable in diagnosing schizophrenia and do not reflect the broad diversity of symptoms that can occur in people with schizophrenia. And just as undifferentiated schizophrenia was an "other" category of schizophrenia that could potentially lump a variety of very different cases under one diagnosis, residual schizophrenia enabled a diagnosis even if the symptoms weren't all that striking. Both subtypes were problematic as they could lead to misdiagnoses and inappropriate treatment. With no longer formal clinical diagnoses, the five subtypes are still used by some clinicians as a way to discuss the nature of a person's condition and explain why certain treatments are needed (say, for paranoia, catatonia, or hallucinations). Symptoms and Diagnostic Criteria How symptoms would lead to a diagnosis of schizophrenia is very different today than in previous editions of the DSM. Today, schizophrenia is understood to take many different forms and can be experienced in different ways by different people. Moreover, the symptoms may not occur all at the same time and can change over time. The formal name was changed to schizophrenia spectrum disorder in 2013 to reflect this. With this in mind, the symptoms of schizophrenia are broken down into five broad categories in the DSM-5: Delusions: These are false beliefs that are strongly held despite evidence that they are not true.Hallucinations: These are the experience of hearing, seeing, smelling, tasting, or feeling things that are not there.Disorganized speech: This is speech that is jumbled, incoherent, and/or illogical.Grossly disorganized or catatonic behavior: These are behaviors characterized by stupor or unresponsiveness, rigidity or unpredictable movements, or mania.Negative symptoms: This is the lack of expected behaviors such as "flat" speech and facial expression, reduced desire for social contact, lack of motivation, and the inability to feel pleasure In order to be diagnosed with schizophrenia today, under the DSM-5, you must:Exhibit at least two of these, with at least one being delusions, hallucinations, or disorganized speech, most of the timeHave symptoms that persist for at least six months and cause significant difficulty in one or more major life areas, such as work, interpersonal relations, or self-care Then vs. Now To be diagnosed with schizophrenia under the criteria set out in previous editions of the DSM, one of the following had to apply: At least two of the above-mentioned symptoms were presentOnly "bizarre" delusions were presentOnly hallucinations including a voice(s) with running commentary were present Based on which combination of symptoms a person had, or which symptoms predominated, a person could be classified as having either paranoid, disorganized, or catatonic schizophrenia. If symptoms were not profound or specific enough to meet the criteria for these subtypes, a diagnosis of undifferentiated schizophrenia would be made.If a person had a schizophrenic episode but no longer had delusions, hallucinations, or disorganized speech, a diagnosis of residual schizophrenia would be made. Schizophrenia Specifiers While there are no longer categories of schizophrenia, there are certain "specifiers" that can help characterize the nature of a person's disease. These include specifiers that describe the severity of symptoms, whether a person has catatonia, and if they have had complete or partial remission. Specifiers can direct which drugs or therapies are most appropriate. Schizophrenia Diagnosis Process Although the criteria for the diagnosis of schizophrenia have changed, the process by which symptoms are identified and classified remains the same. Identifying and classifying the symptoms requires the expertise of a psychiatrist or other certified mental health professional. They are trained to classify and characterize symptoms under a strict set of criteria based on observation and interviews. Other tests may be ordered to rule out somatic (physical) causes of your symptoms. Examination During an examination, a healthcare provider will: Ask about symptomsReview the person's medical historyReview the person's family medical historyPerform a physical examinationRule out other conditions besides schizophrenia Lab Tests There is no lab test that confirms or rules out a diagnosis of schizophrenia. Blood, urine, or other lab tests may be ordered to identify other possible conditions that may explain the person's symptoms. Depending on the situation, a healthcare provider may order a blood or urine test to identify the presence of medications or illicit drugs that could be causing the symptoms. Imaging Tests A magnetic resonance imaging (MRI) or a computerized tomography (CT) may be ordered if there is concern that there could be an underlying physical cause for the symptoms, such as a brain tumor. Once a diagnosis of schizophrenia is established, if the symptoms match more than one subtype but do not meet the criteria for any single subtype, a diagnosis of undifferentiated schizophrenia may be made. In this sense, the classification of undifferentiated schizophrenia is made through a process of elimination. What Causes Schizophrenia? The specific cause of schizophrenia, and by extension undifferentiated schizophrenia, is not known, but there are several risk factors. Age While undifferentiated schizophrenia can occur at any age, symptoms usually begin during the age range of the late teens to the early thirties. Genetics Undifferentiated schizophrenia appears to run in families. Having schizophrenia in the family does not mean a person will develop schizophrenia, but it increases the risk. Compared to the 1% prevalence of schizophrenia in the general population, there is a 10% prevalence among people who have a biological parent or sibling with schizophrenia. The highest risk is associated with identical twins. Having a second-degree relative such as an aunt, uncle, grandparent, or cousin who has schizophrenia also increases a person's chances of developing the condition. It is likely that multiple genes are involved in the development of schizophrenia. Environment It is believed that the interaction between genetics and environmental factors influences the development of undifferentiated schizophrenia. Some environmental risk factors include: Living in povertyLiving with stressPrenatal exposure to viruses or pathogensPrenatal malnutritionHistory of abuse or neglect Substance Use Drugs do not independently cause undifferentiated schizophrenia, but some drugs have been linked to an increased risk of schizophrenia in those who are susceptible. Schizophrenia is linked most closely with use of: CannabisCocaineLSDAmphetamines Research has shown a link between excessive use of cannabis by adolescents and the subsequent development of schizophrenia. Brain Chemistry Dysfunctions of the neurotransmitters dopamine, serotonin, norepinephrine, and epinephrine have been linked to undifferentiated schizophrenia. More specifically, excessive dopamine activity is linked to hallucinations, agitation, and delusions, while abnormalities in norepinephrine are linked to negative and cognitive symptoms of schizophrenia. Brain Physiology Differences in brain structure and function are believed to play a part in undifferentiated schizophrenia. For example: Differences in the volumes of specific components of the brainDifferences in the way regions of the brain are connected and interact These brain differences may begin before birth. Schizophrenia or other forms of psychosis may be triggered by changes to the brain during puberty in those who are susceptible due to genetics, environmental factors, or brain differences. Treatment Although undifferentiated schizophrenia is no longer a recognized category in the DSM-5, the way it was treated in the past is essentially the same as how schizophrenia is treated today. Both then and now, the treatment is individually tailored based on the types, severity, and duration of symptoms a person has. Specifiers can further direct which treatments are the most useful and which are the least. Available treatment options are outlined below. Medication Medication, particularly antipsychotics, is the most common treatment for undifferentiated schizophrenia. Antipsychotic medications can be taken in pill or liquid form, or by injection. Some antipsychotics include: Zyprexa (olanzapine)Risperdal (risperidone)Seroquel (quetiapine)Geodon (ziprasidone)Abilify (aripiprazole)Invega (paliperidone) Side effects of antipsychotics may include: Weight gainDry mouthRestlessnessDrowsiness Some people may be prescribed mood stabilizers such as: Lithobid (lithium)Depakote (divalproex sodium)Tegretol (carbamazepine)Lamictal (lamotrigine) In some cases, people with undifferentiated schizophrenia may be prescribed antidepressants such as: Prozac (fluoxetine) Zoloft (sertraline) Paxil (paroxetine) Celexa (citalopram) Lexapro (escitalopram) Effexor (venlafaxine) Pristiq (desvenlafaxine) Cymbalta (duloxetine) Wellbutrin (bupropion) Never Go "Cold Turkey" Stopping psychiatric medication abruptly can be dangerous. Always consult your healthcare provider before stopping your medication or changing your medication plan. Cognitive Behavioral Therapy (CBT) Cognitive-behavioral therapy (CBT) is a type of ongoing therapy that can be effective for treating many psychiatric conditions. With CBT, people who have undifferentiated schizophrenia can learn to identify maladaptive thought patterns and learn how to challenge them, and change the thoughts and their accompanying behaviors. Family Education and Support These programs are geared towards the family members and close friends of people who have schizophrenia. They aim to help loved ones understand the condition, learn ways to support the person who has undifferentiated schizophrenia, and find support for themselves. These programs can be done individually, as a family, or as a group with other families. Coordinated Specialty Care This type of treatment involves a team of specialists working together to provide help such as: PsychotherapyMedication managementCase managementEmployment and education supportFamily education and support It may be particularly helpful for people in an early stage of schizophrenia called first-episode psychosis. Assertive Community Treatment (ACT) ACT aims to reduce the number of hospitalizations for people with undifferentiated schizophrenia and to decrease the number of people without housing. It involves: A multidisciplinary team, including a medication prescriberA shared caseload among team membersDirect service provided by team membersA high frequency of contact with the person who has schizophreniaA low ratio between staff and the people with schizophreniaOutreach to people with schizophrenia in the community Social Skills Training This treatment uses rehearsing or role-playing real-life situations to help a person with undifferentiated schizophrenia re-learn how to act and interact appropriately in social settings. Supported Employment This program helps people with undifferentiated schizophrenia enter the workforce with support, such as assistance with constructing resumes, preparing for job interviews, and connecting them with employers who hire and support people with mental illness. Substance Use Treatment Excessive substance use can make undifferentiated schizophrenia symptoms worse. Up to 50% of people with schizophrenia have substance use disorders. Substance use treatment is often a part of the treatment program for undifferentiated schizophrenia. Help Is Available If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. For more mental health resources, see this National Helpline Database. Coping Schizophrenia is a life-long condition, so finding coping strategies is important. Some helpful tips for those living with undifferentiated schizophrenia include: With the help of professionals, create and maintain a treatment plan.If prescribed medication, take it regularly as directed and do not stop without consulting a healthcare provider.Eat a healthy diet. Consulting with a dietitian may be helpful.Get plenty of exercise. Exercise is good for both physical and mental health.Manage and minimize stress with techniques such as relaxation, knowing and respecting your limits, and managing your emotions.Get plenty of sleep.Avoid substances like alcohol, drugs, and smoking.Speak with a healthcare provider about changing or adjusting medications if you are not noticing improvement or if your medications are causing bothersome side effects.Set goals and work towards them. Finding Support Living with undifferentiated schizophrenia is difficult to do alone. Having the support of others can make treatment and management of undifferentiated schizophrenia more effective, and make life with schizophrenia more enjoyable. Some ways to find support include: Reaching out to trusted friends, family, and loved onesJoining activities or groups involving things you enjoy such as sports, volunteering, or hobbiesJoining local clubs or organizationsFinding a living environment that makes you feel safe and supports your needs, whether that means living alone, community or supportive living, living with friends or family, or something elseContacting support services in your area Online Support Groups Can Be A Great Resource Some online resources for people with undifferentiated schizophrenia include: National Alliance on Mental Health 1-800-950-6264 Brain and Behavior Research Foundation: 800-829-8289 Schizophrenia and Related Disorders Alliance of America: 800-493-2094 SAMHSA Early Serious Mental Illness Treatment Locator SAMHSA Behavioral Health Treament Services Locator A Word From Verywell Undifferentiated schizophrenia can be hard to recognize and difficult to live with, but with proper support and treatment, it can be manageable. If you are experiencing symptoms of undifferentiated schizophrenia, book an appointment to see your healthcare provider or a mental health professional to get a proper diagnosis, and find a treatment plan that works for you. Frequently Asked Questions How common is undifferentiated schizophrenia? Undifferentiated schizophrenia is an outdated diagnosis for people who meet the criteria for schizophrenia but whose symptoms do not align with any of the four schizophrenia subtypes (also outdated). Today, there is only one category of schizophrenia. It affects up to one of every 155 people in the United States. How long does undifferentiated schizophrenia last? Although schizophrenia is a life-long condition, it can often be effectively managed with treatment. The same may not be true for a related condition called schizophreniform disorder, a short-term psychotic condition that generally lasts for one to six months. 9 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. American Psychiatric Association. What is schizophrenia? Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 changes on the national survey on drug use and health. Cleveland Clinic. Schizophrenia diagnosis and tests. National Institute of Mental Health. Schizophrenia. Nurseslabs. Schizophrenia nursing care and management. Winklbaur B, Ebner N, Sachs G, Thau K, Fischer G. Substance abuse in patients with schizophrenia. Dialogues Clin Neurosci. 2006;8(1):37-43. doi:10.31887%2FDCNS.2006.8.1%2Fbwinklbaur HelpGuide. Schizophrenia treatment and self help. National Institute of Mental Health. Schizophrenia. Heckers S, Barch DM, Bustillo J, et. al. Structure of the psychotic disorders classification in DSM-5. Schizophr Res. 2013 Oct;150(1):11-4. doi:10.1016/j.schres.2013.04.039 By Heather Jones Heather M. Jones is a freelance writer with a strong focus on health, parenting, disability, and feminism. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit